Headaches are common in children and teenagers. Most of them are due to simple factors like not drinking adequate fluids and can be managed by implementing good lifestyle changes. Some of them can be due to migraines, particularly if there is someone else in the family (parent or sibling) who suffers with regular headaches. Very few are due to serious causes like brain tumors and may need scans of the brain, like MRI or CT scan. Pediatric neurologists are able to guide further management after reviewing the symptoms and doing clinical examination of the child.
Common features of migraines
- Head hurts on one side
- The pain is throbbing in nature
- Light and noise make the headaches worse
- The headache lasts for more than 1 hour
- Can feel nausea or vomiting
- Improves after sleep
Common features of other headaches
- Head hurts all over
- The pain is dull and can be as if a band is tied around the head
- Can last for short durations
- Can carry on with other activities usually
Worrying features in headaches
- Headache that comes on quickly and is severe and doesn’t go away
- Headache that wake you up from sleep regularly
- Frequent vomiting with headache
- Change in behavior, becoming very quiet, loss of memory, poor concentration
- Double vision or blurring of vision, or squint
Lifestyle changes to manage headaches
- Drink lots of fluids in the form of water (at least 1-1.5L every day, more in summer)
- Avoid coffee, fizzy drinks, tea
- Sleep and wake up the same time every day, even over weekends
- Sleep adequately for 8 or more hours
- Avoid frequent use of paracetamol, ibuprofen or combinations of these
- Eat regular meals throughout the day, do not skip meals
- Do some light exercise every day
Medical management of headaches
Medicines alone may not always help headaches. They work along with lifestyle changes. There are two types of medicines used: 1. Reliever – this is used when the headache starts and worsens and tries to stop the headaches; and 2. Preventer – this is used daily to minimise the frequency of headaches.
- Reliever medications – these are analgesic medications like paracetamol and ibuprofen, which can be used sparingly to treat headaches. Triptans (sumatriptan, zolmitriptan, rizatriptan) can be used in older children with migraines.
- Preventer medications – these medications are given daily, once or twice a day. They need to be given for some times, at least a month, to see if the frequency of headaches reduces. Some options are propranolol, cyproheptadine, amitryptiline, flunarizine and topiramate.
What else can you do to help your child during a headache?
- Encourage your child to lie down and sleep, this helps the headaches in most cases.
- Draw the curtains to make the room dark and avoid any noises.
- Putting a cool cloth on the head (after dipping in cold water) soothes the headache.
- You could apply any balm on the forehead.